E/M Audits: MAC Sets Up Pre-Pay Edit for Code 99310

Posted on 02. Feb, 2010 by Editor in Provider News.

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87 percent error rate leads to drastic measures.
If you think CMS is only watching your E/M codes when it comes to the office or hospital, think again. One MAC recently reviewed nursing facility care claims and was stunned at the findings.
NGS Medicare, a Part B payer in four states, announced on Jan. 26 that it [...]

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What Lab Coders Need to Know About CCI 16.0

Posted on 31. Jan, 2010 by Editor in Hot Coding Topics.

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Look for transcutaneous hemoglobin limitations, and bundling for those new 2010 culture codes.
Think you’re ready to use all those brand new CPT lab codes? Not so fast. You better learn Correct Coding Initiative (CCI) restrictions first, before you start billing Medicare for services using new CPT 2010 codes.
CCI released version 16.0, effective Jan. 1, which includes 24,060 [...]

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What Medical Coders Should Know About HIPAA Compliance

Posted on 31. Jan, 2010 by Editor in Coder's Cranium.

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If you haven’t been paying much attention to HIPAA compliance lately, here are some good reasons to start.
The Health Insurance Portability and Accountability Act (HIPAA) has been around for awhile, but now more than ever, you need to make sure your practice keeps patients’ protected health information (PHI) private and secure.
Eye opener: HITECH, a part [...]

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E/M Challenge: Can I Report 99214 and +99354?

Posted on 31. Jan, 2010 by suzanne.leder in Coding Challenge.

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Counseling representing more than 50 percent of E/M visit? Choose level based on time.
Question: I have a family physician who documented 60 minutes on an established patient’s office visit. The FP diagnosed the patient with morbid obesity (278.01). Since the patient was newly diagnosed and had some difficulty understanding the doctor’s orders, the FP spent [...]

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Orthopedic Coding Clinic: Labral Tears

Posted on 28. Jan, 2010 by Editor in Hot Coding Topics.

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10-2:00 in the op note signals SLAP lesion repair.
Even experts can land on the wrong ICD-9 code for SLAP lesion repair, but visualizing the injury region as a clock will help you distinguish one type of SLAP (superior labral anterior posterior) tear from another.
Research Patient History for Accurate Diagnosis
Having a solid understanding of anatomy and [...]

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Surgery Coding Challenge: Master Microsurgery Units With This Advice

Posted on 28. Jan, 2010 by suzanne.leder in Coding Challenge.

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Check your EOB to make sure payers don’t apply a multiple-procedure reduction to +69990.
Question: When my ENT uses a microscope during a procedure, what guidelines can I use for choosing between 92504 and +69990? Is there a rule governing how many times you can report the add-on code 69990?
Answer…

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Want to Integrate PQRI Measures Into Your Practice? Look Here.

Posted on 28. Jan, 2010 by suzanne.leder in Toolkit.

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Participation can put extra bread in your basket.
Back again for 2010 is Medicare’s incentive-driven physician quality reporting initiative (PQRI), aimed at tracking quality metric or patient care services that physicians provide. When the practice treats enough patients in the same category, some PQRI dollars might be only a few codes away.
If you know the basics [...]

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How Should I Code a Fibrinolytic Agent Instillation Via Chest Tube?

Posted on 28. Jan, 2010 by suzanne.leder in Coding Challenge.

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Different calendar dates matter, but multiple instillations the same day do not.
Question: My pulmonologist inserted a chest tube and then instilled a fibrinolytic agent to break up multiloculations to free up an entrapped lung. Usually, I use 32560 for this procedure, which is for pleurodesis, not fibrinolysis. What code should I use for fibrinolytic agent [...]

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Pick the Right ICD-9, ICD-10 Code for Postmenopausal Abnormalities

Posted on 26. Jan, 2010 by suzanne.leder in Coder's Cranium.

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Do N95.0 and N95.2 look foreign? Get your ob-gyn ICD-10 equivalents now.
Spare yourself denial hot flashes by taking this three-part postmenopausal abnormality scenario challenge.
Fill In These Blanks Using Your ICD-9 Book
Question 1: Your ob-gyn sees a post menopausal patient with an inflamed vagina because the tissues are thinning and shrinking. The ob-gyn notes decreased vaginal [...]

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Audits: HDI RAC Targets TC, Modifier 26 & More

Posted on 26. Jan, 2010 by Editor in Hot Coding Topics.

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Want to know what RAC contractors will be looking for next? Here’s the link.
Recovery audit contractors (RACs) are working hard to expand their lists of approved issues, and you should keep a close eye on your services in these areas as well.
Health Data Insights (HDI), the RAC contractor for Region D, posted 66 new approved [...]

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Ophthalmology Coding Challenge: Flashers & Floaters

Posted on 24. Jan, 2010 by Editor in Coding Challenge.

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How’s Your EO Coding & Billing? Test Yourself With This Scenario.
Question: A patient reports flashes and floaters but the ophthalmologist does not find evidence of retinal pathology on routine ophthalmoscopy. Are we justified in billing for extended ophthalmoscopy (EO)?
Answer: If the ophthalmoscopy is a routine part of a patient’s eye exam, do not [...]

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Ob-Gyn CCI 16.0: Hysterectomy Coding

Posted on 22. Jan, 2010 by suzanne.leder in Hot Coding Topics.

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Here’s where you can bypass the edits with modifier 59.
The Correct Coding Initiative (CCI) version 16.0 didn’t overlook the hysterectomy, vaginal graft, and colpopexy codes — nor should you. To make sense of the deletions, break these additions into mutually exclusive and non-mutually exclusive.
Note: In all these cases — except those involving the anesthetic injection [...]

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